Editor in Chief Dr KK Aggarwal, Padma Shri Awardee

Dated: 01st May, 2019

Medtalks with Dr KK

1.An agreement between the UK government and food manufacturers to reduce the sugar content of high-sugar foods such as sweets, waffles, pancakes, and breakfast cereals could result in large reductions in diabetes and cardiovascular disease cases but only if it has the intended effect. In 2016, the UK government published Childhood Obesity: A Plan for Action, which set a target to reduce the sugar content of high-sugar products by 20% by 2020, through working with food manufacturers.

2.Deaths following surgery in Scotland dropped by more than a third over a 10-year period. A study in the BJS (British Journal of Surgery) found a 36.6% relative reduction in perioperative mortality since the implementation from 2008 of a surgical safety checklist in Scotland.The 19 item checklist was created by the WHO> nce to established practices and creating a culture of communication and teamwork.

Watchful waiting reasonable for patients with diabetic macular edema and good vision

NIH: Patients in the trial were closely monitored for changes in vision, said Carl W. Baker, M.D. (left). During the 2-year study, the detection of 2 lines of visual acuity loss at one visit or 1 line of visual acuity loss at two consecutive visits prompted aflibercept injections to be given to the people in the laser or observation groups.Brooksie Beard

People with good vision despite having center-involved diabetic macular edema can safely forego immediate treatment of their eye condition as long as they are closely monitored, and treatment begins promptly if vision worsens, according to clinical trial results. The findings are published online today in the Journal of the American Medical Association.

The study was conducted by the DRCR Retina Network (link is external) a multicenter clinical research network funded by the National Eye Institute, part of the National Institutes of Health (NIH).

Diabetic macular edema is the most common cause of vision loss among people with diabetic eye disease in the United States. Diabetes can result in the development of leaky blood vessels in the retina — the light-sensing tissue at the back of eye. Diabetic macular edema is the result of fluid build-up in the central area of the retina, called the macula, which is important for sharp vision. Swelling of the macula can distort vision required for reading and driving.

The evidence from this study should help physicians and patients navigate a common conundrum in ophthalmology: Treating diabetic macular edema in people who still have good vision too soon may subject them to unnecessary costs and risks associated with treatment. Other patients who get treatment too late might risk losing vision permanently.

“We now know that in patients with good vision and diabetic macular edema, similar to those enrolled in this trial, it’s an acceptable strategy to closely monitor patients, and initiate treatment only if their vision starts to show signs of decline,” said the study’s lead investigator Carl W. Baker, M.D., an ophthalmologist at Paducah (Kentucky) Retinal Center.

Controlling blood sugar in diabetic patients helps prevent diabetic eye disease. In addition, therapies that directly target diabetic macular edema — laser photocoagulation and injections of anti-vascular endothelial growth factor (anti-VEGF) agents — reduce or eliminate abnormal leakage from blood vessels.

The trial included 702 participants with diabetic macular edema and 20/25 vision or better, which is considered normal or near normal vision. At the start of the study, participants were randomly assigned to one of the following three management strategies for one of their eyes: 1) inject into the eye the anti-VEGF agent aflibercept (EYLEA®) as frequently as every four weeks, 2) perform laser photocoagulation, or 3) conduct observation of the participants.

During the two-year study, the detection of visual acuity loss prompted aflibercept injections to be given to the people in the laser or observation groups. Aflibercept injections were thus required among 25% of the laser group and 34% of the observation group. Eyes that started aflibercept injections in the laser and observation groups required a similar number of injections overall compared to the group initially assigned to aflibercept.

The researchers checked participants’ visual acuity throughout the study at regular follow-up visits in retina specialty clinics. Researchers measured visual acuity in the laser and observation groups at eight and 16 weeks after study entry, and then every 16 weeks unless their visual acuity worsened.

Daily folic acid supplement may reduce risk of gestational diabetes

NIH study : Taking a folic acid supplement daily before pregnancy may reduce the risk of gestational, or pregnancy-related, diabetes, according to a study by researchers at the National Institutes of Health and other institutions. The findings appear in Diabetes Care.

Folic acid is the synthetic form of folate, or vitamin B9, which is found in leafy green vegetables, nuts, peas, beans and other foods. The U.S. Preventive Services Task Force recommends (link is external) that all women of reproductive age take a daily supplement containing 400 to 800 micrograms of folic acid to reduce the risk of conceiving a child with a neural tube defect, a class of birth defects affecting the brain and spinal cord.

Gestational diabetes results when the level of blood sugar, or glucose, rises too high. It increases a woman’s chances for cesarean delivery and for blood pressure disorders during pregnancy. It also raises the risk of cardiovascular disease and type 2 diabetes later in life. For infants, gestational diabetes increases the risk of large birth size and of obesity during childhood and adulthood.

In the current study, researchers analyzed data from nearly 15,000 women enrolled in the Nurses’ Health Study II (link is external), a long-term study of diet, lifestyle factors and disease outcomes among female nurses. Among more than 20,000 pregnancies, there were 824 cases of gestational diabetes. Compared to women who did not take a folic acid supplement, those who took less than 400 micrograms were 22% less likely to develop gestational diabetes. Those who took 600 micrograms were 30% less likely to develop the condition.

“In addition to reducing the risk for neural tube defects, our findings suggest that taking folic acid supplements before pregnancy might provide a low-cost way to reduce the risk of gestational diabetes,” said the study’s senior author, Cuilin Zhang, M.D., Ph.D., of the Division of Intramural Population Health Research at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

The researchers did not find a lower risk of gestational diabetes associated with consumption of foods that contain high amounts of folate. They cited earlier studies showing that folic acid is absorbed more easily into the body, compared to the naturally occurring form of the vitamin. Researchers also noted that previous studies have found that insufficient folate is associated with insulin resistance (difficulty using insulin to lower blood glucose), which may precede the development of type 2 diabetes in non-pregnant people.

Current Temperature Status and Warning for next five days

Heat Wave and Temperature Observed Yesterday (Past 24 hours from 0830 hrs IST of 29 April to 0830 hrs IST 30 April, 2019)

Heat Wave:

Yesterday, Severe heat wave conditions was observed in isolated pockets over West Madhya Pradesh. Heat wave conditions observed at some parts over Vidarbha and in isolated pockets over Uttar Pradesh, Saurashtra & Kutch, Marathwada, Madhya Maharashtra and East Madhya Pradesh(Annexure 1 & 2).

Maximum Temperature

Maximum temperatures were appreciably above normal (3.1°C to 5.0°C) at most places over Vidarbha & Jharkhand; at many places over Himachal Pradesh, West Rajasthan, Marathawada, East Uttar Pradesh and East Madhya Pradesh; at a few places over Uttarakhand, Jammu & Kashmir, West Madhya Pradesh, Konkan & Goa, Bihar, Odisha and Gangetic West Bengal and at isolated places over Haryana, Chandigarh & Delhi, Chhattisgarh and Saurashtra & Kutch and above normal (1.6°C to 3.0°C) at most places over East Rajasthan, West Uttar Pradesh and Madhya Maharashtra; at many places over Punjab and Gujarat Region and at a few places over Tripura. Yesterday, the highest maximum temperature of 47.4°C was recorded at Khargone (West Madhya Pradesh)(Annexure 1 & 2).

Temperatures Recorded at 1430 Hours IST of Today, the 30th April, 2019

  • Khajuraho(East Madhya Pradesh) recorded the maximum temperature of 45.8°C (Annexure 3).
  • Temperatures recorded at 1430 hours IST of today have risen by 1-3°C at many parts of Uttar Pradesh and Haryana & Delhi and at one or two pockets of East Madhya Pradesh, Jharkhand, West Bengal, Rayalaseema, Tamilnadu, Himachal Pradesh and Manipur (Annexure 4).

Healthcare News Monitor

Hospital Awards’ Jury Meet Conducted To Award Winners

Business World- Prerna Lamba

The first edition of BW Businessworld Hospital Awards, one of the most prestigious event in the healthcare industry, will chart the future roadmap for the industry. A high power jury gathered on Tuesday (29 April) to acknowledge, honour and reward hospitals and leaders for their excellence in the healthcare delivery segment. “It is good to be recognise people and services in a country where there are numerous players present in the healthcare industry”, said Dr K.K. Agarwal. The eminent jury comprised of stellar healthcare industry experts nominated all the winners including Dr K.K. Kalra, Advisor, Association of Healthcare Providers (India) and ex-CEO, NABH; Dr Vijay Agarwal, President, Consortium of Accredited Healthcare Organisations (CAHO); Dr Yashpal Bhatia, Chairman and MD, Astron Healthcare; Shobha Mishra Ghosh, Assistant Secretary General, FICCI; Dr K.K. Aggarwal, President, Heart Care Foundation of India and Former President, IMA; Shhyam R Singhania, Chairman, ENARR Capital; Sudarshan Jain, Secretary General, IPA and Former MD, Abbott Healthcare and Sumit Goel, Partner-Healthcare Advisory, KPMG. The jury was chaired by (Hony) Brig. Dr Arvind Lal, Chairman, FICCI Health Services Committee and Chairman and MD, Dr Lal PathLabs Ltd.

Pharma News

Medical data shows rising diabetes problem in Karnataka

Deccan Herald-Akhil Kadidal

The release of medical data compiled by an online pharmaceutical company has revealed a gap in doctor-to-patient ratios across India and a high incidence of diabetes in Karnataka. Released last week as part of a campaign to link the health of the nation with the Lok Sabha elections, the medical data which was provided by Medlife, came in the form of 29 report cards — one for each state — showing that the treatment gap in state— showing that the treatment gap in states such as Uttar Pradesh was as wide as one doctor per 20,000 patients. In Karnataka, the ratio is one doctor for every 13,699 patients and one bed for 326 patients. The dataset also showed that the state had a death rate of 42 people every day to diabetes. “Operationally and administratively, these centres are set below the Primary Health Centre (PHC) level, and through them, we hope to tackle a wide range of non-communicable diseases in the state, including diabetes,” Dr Prabhakar said.

Glenmark Pharma launches anti-diabetes drug in India

Business Today-PTI

Drug major Glenmark Pharma Tuesday announced the launch of its anti-diabetes drug Remogliflozin in India. "Glenmark is the first company in the world to launch the novel SGLT2 inhibitor Remogliflozin and India is the first country to get access to this innovative drug...The drug is indicated in the treatment of type-2 diabetes mellitus in adults," the company said in a regulatory filing. SGLT2 inhibitors are oral anti-diabetes drugs that provide glycemic control, induce weight loss and reduce cardiovascular risks. Glenmark said it will commercialise Remogliflozin in India under the brand names 'Remo' and 'Remozen'. Glenmark said it received regulatory approval for Remogliflozin etabonate 100 mg tablets after successfully completing phase-3 clinical trials.

A grievous crisis is brewing in India’s healthcare system

The Asian Age- Jagdish Rattanani

About two years ago, Stanford University’s Dr John P AIoannidis, who is currently considered the most-cited physician, wrote in the prestigious Journal of Clinical Epidemiology: “Under market pressure, clinical medicine has been transformed to finance-based medicine… In many places, medicine and healthcare are wasting societal resources and becoming a threat to human well-being. Science-denialism and quacks are also flourishing and leading more people astray in their life choices, including health… We have supported the growth of principal investigators who excel primarily as managers absorbing more money.”

Scientists establish zinc supplementation can prevent fatty liver disease

Mint-Neetu Chandra Sharma

Indian scientists have established that nanoparticles of zinc oxide (ZnO) can prevent fat accumulation in the liver and thereby prevent Non-Alcoholic Fatty Liver Disease (NAFLD) that has become a common medical condition given currently prevalent food habits and lifestyle. A research team from Indian Institute of Technology (IIT) Mandi and Council of Scientific & Industrial Research (CSIR) -Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, using cell and mice models has shown that zinc supplementations either in the form of nanoparticles or salts are effective in reducing fat accumulation in the liver and inducing peripheral insulin sensitivity. “NAFLD is a condition in which the body creates too much fat that gets stored in the liver cells, called steatosis, which could lead to scarring or cirrhosis, and eventual liver failure," said Prosenjit Mondal, Assistant Professor, School of Basic Sciences, IIT Mandi, and Debabrata Ghosh from CSIR-IITR.

Delhi HC notices on ban on sale of medicines online

India Post

The Delhi High Court has issued notices to the Centre and some e-pharmacies on a contempt petition alleging non-compliance of the court’s order staying sale of drugs and prescription medicines by online pharmacies. A bench of Chief Justice Rajendra Menon and Justice A.J. Bhambhani sought responses of the Ministry of Health, Central Drugs Standard Control Organization, Drugs Controller of Delhi and various private e-pharmacies on the contempt plea. The court put up the contempt plea for May 9, when the main petition seeking a ban on “illegal” sale of drugs and medicines online is also listed. Petitioner Zaheer Ahmed, represented through senior advocate Arvind Nigam and advocate Nakul Mohta, said in the contempt petition that despite the stay order by the high court on sale of medicines online, the government has wilfully and deliberately not taken any action to stop it. The counsel claimed that the e-pharmacies in wilful disobedience of the order passed by the high court are selling medicines online. “The respondents/contemnors by acting in wilful disobedience of the order are not only lowering the majesty of court, but also putting the public health at grave risk,” the plea said.

Using AI to detect mental health disorders likely to be counterproductive

Medical Dialogues

Advances in artificial intelligence (AI) technology have made it possible to detect mental disorders such as anxiety and depression from cues in a person’s voice, but doctors warn that adopting such tools in haste may prove to be counterproductive. Despite the staggering number of patients being reported to suffer from disorders like depression, India struggles with the stigma of mental health diseases — deterring patients from getting the right help in time. AI-based vocal analytics may allow patients to detect the disease at home by just speaking into a smartphone application — eliminating the need to be physically present at treatment facilities for diagnosis.“This technology will be helpful to people who are bound by the stigma of going to a doctor for therapy or diagnosis,” Dr Rajendra Singh, a psychiatrist based in Bhopal, told PTI. Last year, CompanionMx, an application developed by the behavioural analysis firm Cognito Corp, launched an AI-based mobile mental health monitoring system, clinically validated by the Harvard Medical School in the US. The app uses objective data instead of self-reports to track the mood of the users by analysing their voice for acoustics and behavioural biomarkers, in order to predict the core symptoms of mood and anxiety disorders.

Know how malaria affects children, its symptoms and preventing the disease

Express Parenting

Malaria is a parasitic infection which presents with high fever in children in hot, tropical countries like India. Malaria can be a life-threatening illness in children. Malaria is caused by a parasite called plasmodium, carried by mosquitoes, which pick it up by biting someone who already has the disease. Malaria is then passed to other people when the mosquitoes bite them. There are other ways to contract malaria, which includes from a pregnant mother to her unborn baby or through blood transfusion and organ donation, but they are rare.

20% Of Medicines Sold In India Are Fake As Per US Trade Body

Trak.in- Malvika Gurung

Where do you ought to turn, when you learn that the system you rely on for leading a disease-free, healthier life, is among the top listed countries selling counterfeit pharmaceutical products to not just its local markets but also major foreign markets? India is among the leading global producers of low-cost generic medicines, mainly due to high local demands and inexpensive manufacturing costs. Our pharmaceutical market constitutes the third largest in terms of volume but 13th when it comes to quality. It has been found that the drugs prescribed by a doctor are mostly adulterated to a certain degree, even the most popular ones like Crocin or Betadine.

Healthcare News

Vaccinations Are Not Just For Children

Express Healthcare

Dr Tarun Sahni, Senior Consultant, Internal Medicine, Indraprastha Apollo Hospitals gives an insight on the importance of vaccines The ongoing World Immunisation Week is an opportunity to promote vaccination amongst communities and people to ensure their health and protect them against communicable and non-communicable diseases. Widely recognised for its success in saving lives of millions of people world over, nationwide immunisation programmes have helped reach out to even the unreachable communities with cost-effective health interventions. Vaccination is not just alone meant for children. They are meant to support good health and add value in the life of an adult. Vaccines protect us at every stage of our life. In adult life, one needs to get vaccinated to boost efficacy of the vaccines given in childhood.

Kochi hospital bags ‘responsible critical care’ certification

The Hindu

Responsible Critical Care Units, a new standard introduced by the Association of Healthcare Providers-India (AHPI), in association with the Indian Society of Critical Care and Medicine (ISCCM), and Bureau Veritas, was on Tuesday awarded to all the 14 intensive care units (ICUs) at Lisie Hospital. The standards are for ensuring quality and responsible care in the ICUs, which are considered hospitals’ threshold centres in controlling infections and hospital-induced infections. The certification will be valid for three years. Lisie has been awarded the Platinum certification with 98.5 points scored on a scale of 100, said the Lisie Hospital director Fr. Thomas Vaikathuparambil at a press meet held on the occasion. The certification was awarded, taking into account the hospital’s antibiotic and other medicine administration policy, infection control, biomedical waste management and affordable quality care, said the hospital director. It was also the only hospital in South India to get the certification, he said.

Antibiotics: Why Asking Doctors to Prescribe Fewer is Futile

The Wire

An 85-year-old woman with dementia is admitted to hospital with worsening confusion, new urinary incontinence and constipation. These symptoms suggest a urinary tract infection, but the doctor treating her has a dilemma because the symptoms also suggest her dementia may be worsening or that she has simple constipation. Sending a sample to a lab for analysis could confirm bacteria in the urine, but getting a result takes days, so the doctor decides to play it safe and prescribe antibiotics. Scenes like this are repeated every day in hospitals around the world, and they are leading to excessive and often unnecessary antibiotic use. The inevitable consequence is the evolution of resistant bacterial strains. Bacterial genes undergo continual mutation. When a colony of bacteria is exposed to an antibiotic, a mutation may eventually occur in a single member of the colony, making it immune to the antibiotic. This lucky mutant will then reproduce rapidly as its mutation spreads through the entire colony – as the video below illustrates.

Medical Officer being Shown as Medical Faculty: Telangana Doctors cry out GHOST faculties

Medical Dialogues

Allegations of ghost faculty have surfaced against Suryapet Medical College by the Telangana Junior Doctors Association (TJUDA) which has stated that medical officers under the Directorate of Health are being shown as faculty members in a bid to gain Medical Council of India (MCI) nod following the inspections. According to a recent report by TOI, when the MCI inspections were being done at the medical college recently, the management presented the ghost faculty to gain permission by the MCI to run medical courses for the academic year 2019-20. Alleging this foul play, President Telangana Junior Doctors Association (TJUDA), Dr PS Vijayender Goud told the TOI, ” The management of Suryapet Medical College is showing medical officers under the Directorate of health as faculty members. Although the medical colleges should recruit all faculty members as per the required strength and then go for inspections, a few medical colleges are not doing this. instead of recruiting regular faculty members, colleges are resorting to shortcut ways like showing medical officers of Primary Health Centres (PHCs) as faculty members.”

You can do this miracle

Deccan Herald

Hospitals are places where one gets to witness a range of emotions. The sadness and anguish of the kin of a deceased patient contrasts with the feeling of hope of a patient who has just been given a good prognosis by doctors for his life-threatening illness. This is why most people are anxious as they enter the building that smells like bleach -- the uncertainty of the news one may get in the consultation room. But it’s often a place where miracles happen. Organ donation and transplantation (ODT) is one such miracle that impacts not just an individual but several families at once. Upto eight organs can be donated by a deceased patient to different recipients, and two by a living donor. But the challenges faced in India with respect to ODT have been perennial ones. According to the NGO Organ India, the number of kidney transplants required annually is about two lakh, but only some 10,000 take place; the number of heart transplants required is about 50,000, only about 340 take place. There are similar statistics with regard to other organs, too. The organ donation rates are at about 0.8 persons per million in India, compared to 32 persons per million in the US and 42 in Spain.

Health dept plans ‘cool rooms’ in Pune to deal with heatstroke victims

Hindustan Times

In lieu of the temperature in the state touching 40 degrees and more in the last few days, Dr Subhash Salunkhe, chairman, state’s prevention and control of diseases committee said, “We have decided to start cool rooms in health centres of cities which would record a temperature of 40 degrees or more for the next one month. The initiative is to provide immediate relief to the patients from heatstroke. The room will have two fans of which one will be an exhaust fan and another will have sprinkles.” Salunke said that water at room temperature should be poured on the head of person suffering from heatstroke. Heatstroke, also known as sunstroke, usually results in dizziness, redness, severe headache and also fainting.

Paras Hospital's Orthopaedic Department Gains Recognition Worldwide

Business Standard

Paras HMRI Hospital, Patna achieves an AO Fellowship accreditation by Switzerland-based 'Association of Surgeons for Internal Fixation of Fracture' The hospital helped two patients suffering from walking disorders get back on their feet post surgery. These patients had given up hope after getting surgeries done at hospitals in Delhi and Lucknow The Orthopedic department at Paras HMRI Hospital, Patna has earned a worldwide reputation for quality, which is why it will now be able to offer the renowned AO fellowship to doctors from all over the world. Paras Hospital, Patna has now become the first hospital in eastern India to offer an AO Foundation course. A nod in this regard was given to the orthopedic department of the hospital by the Switzerland-based Association for the Study of Internal Fixation recently.

Government doctors to hold demonstrations in June over NEET, PG quota issues

The New Indian Express- Sinduja Jane

Come June, government service doctors may stage series of demonstrations, urging the State government to abolish UG-NEET for MBBS and BDS admissions and also restore 50 per cent reservation for government service doctors in PG medical admissions, after only 43 per cent of medical seats were allotted to the service doctors in the first phase of PG medical counselling this year. According to the selection committee, “In the first phase of counselling, in all, 999 PG (MD and MS) seats were allotted for government and self-financing colleges; 427 seats were allotted to government service doctors and 572 for non-service doctors. That is, 43 per cent seats were allotted to government service doctors and 57 per cent seats to non-service doctors.

Steps on to resume classes at Idukki medical college

The Hindu

The government will take necessary steps to restart classes in Government Medical College, Idukki, this academic year itself after securing the recognition of the Medical Council of India before May 31. The decision was taken at a high-level meeting convened by Health Minister K. K. Shylaja here on Tuesday. The Principal Secretary (Health) will visit the college to assess the situation for himself. So far, two MCI inspections have taken place. The meeting assessed that the institution had acquired adequate infrastructure to win MCI’s approval for 50 MBBS seats. An ambulance purchased using the MP funds of Joyce George would be made available to the college for use. The recognition for the academic block, strengthening of radiation division and environmental clearance will be the immediate steps.

Why do manufacturing units differ in quality for export and indigenous supply of drugs?

A few days back in a stakeholders meeting, a senior medical colleague raised a very important issue that pharmaceutical companies have two different types of plants; one, where they manufacture drugs for export and second, which manufacture drugs for sale in the country.
For indigenous manufacturing and supply, they only rely on Good Manufacturing Practice (GMP) certification.
But for international supply, they also comply with the stringent United States Food and Drug Administration (FDA) and Medicines and Healthcare products Regulatory Agency (MHRA) of the United Kingdom (UK) certification standards.....read more

Paint your plate with the colors of the rainbow: Include all 7 colors and 6 tastes

The most recent US Dietary Guidelines recommend consuming even more: 2 1/2 cups of vegetables and 2 cups of fruit, based on a 2,000-calorie diet. The American Cancer Society recommends 2 1/2 cups per day of fruits and vegetables.
All vegetables, fruits, whole grains, nuts, beans contain phytonutrients. Phytonutrients have potent anti-cancer and anti-heart disease effects besides other health benefits......read more


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